Novel digital pet game within smoking cessation app increases user engagement with app’s tools to quit smoking

FOR IMMEDIATE RELEASE

Thursday, October 31

Contact:

Jillian McKoy, jpmckoy@bu.edu

Michael Saunders, msaunder@bu.edu

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Mobile apps that offer smoking cessation support can be effective alternatives to conventional clinical treatment for people who want to stop smoking—but user engagement is key to this success. 

A novel pet retention game integrated into a popular smoking cessation app is showing promise as an effective opportunity to increase user engagement and retention, according to a new study led by a Boston University School of Public Health (BUSPH) researcher.

Published in the Journal of Medical Internet Research, the study evaluated the effectiveness of Inner Dragon, a multifaceted game embedded within the Smoke Free smoking cessation app that prompts users to care for a customizable pet dragon, whose growth reflects the person’s progress towards quitting smoking. The game also encourages use of smoking cessation tools within the app. Among the study participants who had access to Inner Dragon, overall engagement with the Smoke Free app increased by 20 percent compared to those who did not have access to the game, and direct use of the app’s smoking cessation tools increased by a notable 30 percent. 

The study is the first to assess a game integrated into an existing smoking cessation app, and the Smoke Free app has established success as one of the most-used apps of its kind, with more than seven million downloads. The new findings suggest that in-app gamification can be a cost-effective, easily accessible, and convenient intervention to boost users’ engagement with smoking cessation support and educational tools that can aid them in their goal to quit smoking. 

Cigarette smoking remains a leading cause of preventable death in the United States, afflicting more than 16 million Americans with a smoking-related disease and killing nearly 500,000 people each year.

“Many smokers are increasingly turning towards mobile phone apps to seek support for smoking cessation, but user engagement is a concern,” says study lead and corresponding author Dr. Justin White, associate professor of health law, policy & management at BUSPH. “People will often download the apps, use them a couple of times, and then delete them or forget about them. In Inner Dragon, an evolving pet dragon keeps users engaged with the game and app by serving as a visual representation of their progress in their quit attempts and, more broadly, their personal growth.” 

For the study, Dr. White and colleagues conducted a randomized control trial featuring 479 US participants ages 18 and older who had downloaded the Smoke Free app and had plans to quit smoking within seven days. A portion of the participants had access only to the “core” features of the smoking cessation program, which included support tools such as a diary and cravings log, guidance on quitting, daily task suggestions to help resist urges, and a calculator to track the amount of money saved from not buying cigarettes. The remaining participants had access to all of the core features, as well as the Inner Dragon game. The participants could use the app however they wished for eight weeks after their identified quit date, ending with a follow-up survey.

The team relied on behavioral science principles to design the Inner Dragon game, incorporating elements that motivate users to quit smoking, such as in-game rewards for smoking abstinence and tactics that promote therapeutic bonding with the digital pet dragon as it grows with their progress. Users can customize their pet dragon, and they receive points for completing certain activities, such as feeding or petting the dragon. They also receive points for interacting with the core educational content within the app.

In addition to an increase in user engagement with the Smoke Free app and its smoking cessation tools, the researchers found that the more users engaged with the app, the more likely they were able to abstain from smoking. They also observed higher rates of abstinence among younger participants and low-income participants.

“Every time users opened the app, it asked if they had smoked in the last day, and on that measure, there was a substantial improvement,” Dr. White says. Moreover, participants who used the game more often were more likely to abstain from smoking. 

However, smoking abstinence outcomes were varied between the two groups, and the researchers did not conclusively observe that interaction with the game and app led to higher rates of smoking cessation. 

In future studies, the team plans to refine individual features of the Inner Dragon game and adjust their methodology to better understand possible links between user engagement and smoking abstinence.

“We know that standard treatments for smoking cessation, such as counseling and prescription medications are effective, but if many people are turning to these types of apps, we have to meet individuals where they are,” says Dr. White. “Embedding gamification within an app that we already know is evidence-based and effective, along with behavioral science tools, can be a really promising approach.” 

The study’s co-senior authors are Dr. J. Lee Westmaas, scientific director of tobacco control research at the American Cancer Society, and Dr. Johannes Thrul, associate professor in the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health. The study was also coauthored by Dr. Séverine Toussaert of the University of Oxford, Dr. Bethany R. Raiff of Rowan University, Marie K. Salem of UCLA Fielding School of Public Health, Dr. Amy Yunyu Chiang of the University of California, San Francisco, Dr. Courtney R. Lyles of the University of California, Davis, Dr. Lorien C. Abroms of George Washington University Milken School of Public Health, and David Crane and Edward Warrender of 23 Limited, who developed the Inner Dragon game.

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About Boston University School of Public Health

Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.